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Wednesday, 26 November 2014

(Preview) Most common diseases of 50 plus - Thyroid Disease - Hashimoto’s thyroiditis : Preventions, Managements and Treatments

By Kyle J. Norton 
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

                                          Thyroid disease
          Thyroid disease is defined as a condition of malfunction of thyroid gland.

     Thyroid disease : Hashimoto’s thyroiditis

Hashimoto’s thyroiditis (chronic lymphocytic thyroiditis) is an autoimmune disease in which the immune system attacks the thyroid gland, causing an underactive thyroid gland (hypothyroidism).
According to the study by the University of Pisa, Women with Hashimoto’s thyroiditis (HT) suffer from symptoms independently from hypothyroidism and regardless thyroid dysfunction(a).

A. Symptoms
1. Dysphagia, shortness of breath, voice changes, and odynophagia
 According to the ata of patients who underwent thyroidectomy from 2005 through 2009, by the Medical University of South Carolina, 52%,  26% and 8% of patients experienced symptoms of dysphagia and shortness of breath; voice changes, and complained of odynophagia, respectively(1).

2. Anxiety, negative mood, depression, dry skin, cold intolerance, puffy eyes, muscle cramps and fatigue, deep voice, constipation, slow thinking and poor memory.
Hashimoto’s thyroiditis is a common auto-immune disorder. The most common presenting symptoms may include anxiety, negative mood, depression, dry skin, cold intolerance, puffy eyes, muscle cramps and fatigue, deep voice, constipation, slow thinking and poor memory, according to the study by the Leiden University Medical Center(2).

3. General health
Women with Hashimoto’s thyroiditis (HT) also with positive anti-thyroid autoantibodies(anti-TPO) are experience to a significantly higher prevalence of general health symptoms as compared to those without HT(2a).

4. Other symptoms
Swelling in front of the neck along with constipation, anorexia, weight gain and increasing pallor may also be symptoms of hypothyroid goiter (autoimmune thyroiditis, Hashimoto’s thyroidits), due to high level of  thyroid stimulating hormone (TSH), low level of  T4 with presence of thyroid specific antibodies in blood(2b).

B. Causes
1. Autoimmune disorder
The current knowledge on Hashimoto’s thyroiditis associated with concept of autoimmune thyroid disease is caused by autoimmune process in stimulation of  abnormal production of antibodies, reacting with thyroglobulin and thyroid peroxidase(3a).

2. Primary hyperparathyroidism (PHPT)
Patients with primary hyperparathyroidism (PHPT) are susceptible to develop Hashimoto’s thyroiditis due to similar autoimmune inflammatory process with the rate ofoccurrenceof 1.89%(3).

2. Cerebellar ataxia
Both hypothyroidism and Hashimoto’s thyroiditis (HT) can rarely be associated with cerebellar ataxia.
but patients with hypothyroidism with history of severe essential tremor may develop Hashimoto’s thyroiditis(4).

C. Risk factors
1. Childhood weight gain and childhood overweight
Childhood weight gain and childhood overweight conferred an increased risk to later hypothyroidism and thyroid autoimmunity, particularly in women, according to the study by the Medical Research Council Unit for Lifelong Health and Ageing(5).

2. Genetic factors
CTLA-4 gene located in chromosome 2q33 region has a strong association with several autoimmune diseases, including Hashimoto’s thyroiditis(6).

3. Female
If you are female with type I diabetes, you are at increased risk for the development of HT,
according to the study of thyroid autoimmunity in a very large nationwide cohort of children and adolescents with type 1 diabetes, 63% of type I diabetes patients with positive antibodies were girls, compared with 45% of patients without antibodies(7).

4. Other risk factors
According to the study by the Kaunas University of Medicine, pregnancy, drugs, age, sex, infection, and irradiation may also be associated to the risk factors of Hashimoto's thyroiditis (HT)(8).

D.  Diseases associated to Hashimoto’s thyroiditis
1. Hashimoto’s encephalopathy (HE)
Hashimoto’s encephalopathy (HE) is a rarely recognized neurocognitive syndrome associated with thyroid autoimmunity and occurred more common in women(14).

2. Neurofibromatosis Type 1
Hashimoto’s thyroiditis is a common form of chronic autoimmune thyroid disease (AITD) and often coexists with other autoimmune diseases, including Hashimoto’s thyroiditis(15).

3. Chronic hepatitis C(CHC)
The prevalence of of thyroid dysfunction is significantly higher among Chronic hepatitis C patients with Hashimoto’s thyroiditis(HT) than CHC patients without HT(16).

4. Reactive thrombocytosis
 Reactive thrombocytosis, an elevated platelet count (> 450,000/μL) developed secondary to another disorder, including Hashimoto’s thyroiditis and/or subclinical hypothyroidism(17).

5. Thyroid papillary carcinoma
Patients with Thyroid papillary carcinoma are associated to 26.8% risk of HT without differences in relation to tumor size(18).

E. Misdiagnosis
Although fine-needle aspiration (FNA)is extremely valuable in the initial evaluation of thyroid lesions,  with an accuracy of 98.6% and 80% positive predictive value, and 100% negative predictive value, misdiagnosis can be abserved(19).

1. Overlapping thyroid follicular lesions coexisting with Hashimoto’s thyroiditis
 Overlapping cytological features of FN and HT were showed to be the main causes of false-positive results in diagnosis of thyroid follicular lesions coexisting with Hashimoto’s thyroiditis' dominant in some patients, if not taken account of presented forms of follicular-cell  and/or moderate to excessive numbers of lymphoid cells(20).

2. Papillary thyroid carcinoma (PTC)
An association between papillary thyroid carcinoma (PTC) and Hashimoto’s thyroiditis (HT) is well recognized, but papillary thyroid carcinoma (PTC)  is most often misdiagnosed as either follicular neoplasm or colloid nodule with or without HT(21).

3. Follicular adenoma, nodular goiter, macrofollicular adenoma and malignant lymphoma
 Hashimoto’s thyroiditis (HT) can be misdiagnosed as follicular adenoma, nodular goiter, macrofollicular adenoma and malignant lymphoma, if  FNABs an associated lesion was not sampled or some of the cellular features of HT were misinterpreted(22).

4. Solitary thyroid nodule
 Solitary thyroid nodule also can be misdiagnosed as Hurthle cell neoplasm on FNAC in patients of Hashimoto’s thyroiditis with marked Hurthle cell change(22a).

F.  Diagnosis
After recording the past and present history and completing a physical exam, including assessing symptoms and complaints commonly seen in hypothyroidism and neck examination. The tests which your doctor orders may include
1. Blood test
The aim of the test is to determine the level of thyroid function. Underactive thyroid gland is presented with the low level of thyroid hormone with elevated TSH as your pituitary gland tries to stimulate your thyroid gland to produce more thyroid hormone.

2. An antibody test
The aim of the test is to check for the presence of antibodies against thyroid peroxidase, the an enzyme which plays an important role in the production of thyroid hormones.

3. Thyroid scan
Thyroid scan in Hashimoto’s thyroiditis can mimic a wide range of thyroid disorders, due to overlapping (23).

4. Fine needle aspiration cytology
FNAC can accurately diagnose Hashimoto’s thyroidits in most patients. However, a small percentage of cases may be missed due to the limitations of this procedure and the varied sell structures of the disease (24).

G. Prevention
G.1. Diet to prevent Hashimoto’s thyroiditis

1. Brazil Nuts and Sunflower Seeds
Selenium found abundantly in Brazil Nuts and sunflower seeds was significantly related to the production of thyroid gland. A low selenium status significantly increased the risk for thyroid enlargementand and  development of multiple nodules(25a). Overdose may have a toxic effect on growth hormone, causing adverse effects of anorexia, diarrhea, depression, hemorrhage, liver and kidney necrosis, blindness, ataxia and respiratory disturbances(25).

2. Sea buckthorn
Sea buckthorn (Hippophae rhamnoides L.) constitutes thorny nitrogen fixing deciduous shrub. Sea buckthorn(SBT) is primarily valued for its very rich vitamins A, B(1), B(12), C, E, K, and P; flavonoids, lycopene, carotenoids, and phytosterols. and therapeutically important since it is rich with potent antioxidants. Scientifically evaluated pharmacological actions of SBT are like inflammation inhibited by reduced permeability, loss of follicular aggregation of lymphocytes from the inflamed synovium and suppress lymphocyte proliferation(26).

3. Balanced diet
Several trace minerals, including iodine, iron, selenium, and zinc. and trace elements are essential for normal thyroid hormone metabolism, Coexisting deficiencies of these elements can impair thyroid function. Iron deficiency impairs thyroid hormone synthesis and reduces the efficacy of iodine. Combined selenium and iodine deficiency leads to severely stunted physical and mental growths(27).

G.2. Phytochemicals and Antioxidants to prevent and treat Hashimoto’s thyroiditis
Patients with in Hashimoto’s thyroiditis (HT)  were found to significant increase in oxidative stress parameters in serum and LDL-fraction(28).
1. Resveratrol
Resveratrol, found in skin and seed of grape regulates several biological processes, including sell cycle arrest, in both papillary and follicular thyroid cancer. resveratrol also influences thyroid function by enhancing iodide trapping and increasing TSH secretion(29).

2. Polyphenolic flavonoids
Polyphenolic flavonoids found in black and green tea extracts showed to alter the thyroid gland physiology and architecture, including inhibited enlargement of thyroid gland, decreased serum T3 and T4, and a parallel increase in serum thyroid stimulating hormone (TSH) at green tea extract at 2.5 g% and 5.0 g% doses and black tea extract at 5.0 g% dose(30).

3. Selenium
According to the study by the Hôpital du Cluzeau, selenium supplementation decreases anti-thyroid antibody levels and improves the ultrasound structure of the thyroid gland(31).

2. Vitamin D
Vitamin D deficiency may have a role in the autoimmune process in Hashimoto thyroiditis in children.
 Children with Hashimoto thyroiditis showed to associate with higher vitamin D deficiency rates in comparison to vitamin D levels in the Hashimoto group(32).

H. Treatments
A. In conventional Medicine
1. Levothyroxine therapy
Beside monitoring thyroid functions of the patients with HT periodically for hypothyroidism, treatment of Levothyroxine therapy is necessary to improve positively affect the clinical course of the disease and the antibody titers(33).

2. Combination of liothyronine (T3) and levothyroxine
Although ombinations of levothyroxine plus liothyronine appear to have beneficial effects on the mood, quality of life, and psychometric performance of the patients over levothyroxine alone with the possibility of adverse effects, large sample size is necessary for further study(34).

H.2.In Herbal Medicine
1. Alkaloid tetrandrine
According to the study by the Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, TTetrandrine (Tet), purified from a creeper Stephania tetrandra S Moore, used to treat patients with silicosis, autoimmune disorders, and hypertension in Mainland China for decades. exhibited a wide variety of immunosuppressive effects both in vitro and in vivo(38).

2. Salvia miltiorrhiza, Tripterygium wilfordi, Tanacetum parthenium and Curcuma longa
A number of herbal products used for their immunosuppressive effects, may be useful in immune-mediated disorders including autoimmune diseases and organ transplant rejection, including  Salvia miltiorrhiza and Tripterygium wilfordii functions in reduced inflammatory cytokines and mediators, Tanacetum parthenium function in  inhibited the release of pro-inflammatory mediators and Curcuma longa function in down regulates the expression of inflammation(39).

3. Radix Bupleuri
Radix Bupleuri, used most frequently prescribed crude herbs in the prescriptions of traditional Chinese medicine for the treatment of inflammatory diseases and auto-immune diseases showed to inhibit production of serum autoantibodies and total immunoglobulin G (IgG) with doses depended for 35 days
(40).

4. Polygonum multiflorum and Artemisia scoparia
According to the study by the National Taiwan University, emodin and scoparone, the active principles isolated from Polygonum multiflorum and Artemisia scoparia, respectively, both exhibit vasorelaxant and immunosuppressive effects. In dose depended the phytochemicals also suppressed the responses of white blood cells with a one-lobed nucleus, and cell proliferation(41).

H.3.  In traditional Chinese Medicine
1. Aconite cake-separated moxibustion and option the better therapeutic program
Application of aconite cake-separated moxibustion therapy with acupoints of [(1) Danzhong (CV 17), Zhongwan (CV 12), Guanyuan (CV 4); (2) Dazhui (GV 14), Shenshu (BL 23), Mingmen (GV 4)] alternatively with oral administration of 25 microg Euthyrox everyday, showed to improve clinical symptoms and thyroid function in patients of Hashimoto’s thyroiditis, in comparison of simple oral administration of Euthyrox (levothyroxine)(35).

2. Brown seaweed Sargassum
 Sargassum spp., a brown seaweed, used in Traditional Chinese Medicine (TCM) to treat a variety of diseases over 2000 years including thyroid disease, exhibited its immunomodulator effects and could be useful in the treatment of thyroid related diseases such as Hashimoto’s thyroiditis(36).

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References
(1) http://www.ncbi.nlm.nih.gov/pubmed/22191404
(2) http://www.ncbi.nlm.nih.gov/pubmed/23744563
(2a) http://www.ncbi.nlm.nih.gov/pubmed/21112862
(2b) http://www.ncbi.nlm.nih.gov/pubmed/21381622 
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